Preventing and Managing Peripartum Cardiomyopathy (PPCM) in Pregnant Women

Peripartum cardiomyopathy (PPCM) is often mistaken for ordinary pregnancy complaints, even though it can have serious consequences.

01 / Heart Disease

What Is Peripartum Cardiomyopathy (PPCM)?

Peripartum cardiomyopathy (PPCM) is a heart condition in which the heart muscle weakens toward the end of pregnancy or in the months after giving birth. In PPCM, the left ventricle of the heart becomes enlarged and its ability to pump blood decreases. As a result, the amount of oxygen-rich blood circulated throughout the body drops. This condition triggers complaints such as fatigue, shortness of breath, and swollen legs, which are symptoms of heart failure after giving birth.

Symptoms of Heart Failure After Giving Birth

In the early stages, PPCM symptoms often resemble normal pregnancy complaints. Shortness of breath usually appears during activity or when lying down, along with excessive fatigue and swelling in the ankles and legs. In addition, some pregnant women may also feel heart palpitations or mild chest pain. That is why, if these symptoms appear, you should see a doctor promptly. Early detection of heart failure and the use of routine heart checkup services to monitor your health from the start are strongly recommended.

Although the exact cause of PPCM is not yet known, experts have found several factors that may increase the risk. In addition, pregnancy-related hypertension (preeclampsia), maternal age over 30, and multiple pregnancy are among the commonly cited risk factors. That is why pregnant women with these risk factors need to stay alert and have their heart health checked regularly. These causes and risk factors are discussed further in the next section.

02 / Heart Disease

Why PPCM Happens: Causes and Risk Factors

Peripartum cardiomyopathy (PPCM) occurs when the heart is unable to adapt to the major changes that take place during pregnancy and after childbirth. This condition is influenced by a combination of physical and hormonal factors and health history. Understanding these causes and risk factors can help mothers and families stay alert from the start.

Increased Workload on the Heart During Pregnancy

During pregnancy, the body naturally increases its blood volume by about 30 to 50% to meet the needs of the mother and the fetus. As a result:

• The heart has to pump more blood every second.
• The heart muscle works harder than usual.
• If the heart’s capacity is limited, this extra load can trigger a decline in the heart’s pumping function.

Cardiology research notes that this increased load is one of the early triggers of changes in heart structure and function in some mothers.

Hormonal Changes and Oxidative Stress

Hormonal changes during pregnancy affect not only mood or metabolism, but also the heart muscle cells.

• Hormonal fluctuations can increase oxidative stress, which is an imbalance between free radicals and antioxidants in the body.
• Oxidative stress can damage heart muscle cells and weaken their ability to pump.

Several studies show that high levels of oxidative stress are found in most cases of PPCM.

The Role of Prolactin and Inflammation

One important finding in recent years is the role of the hormone prolactin. Under oxidative stress:

• Prolactin can break down into fragments that are toxic to heart cells.
• These prolactin fragments trigger inflammation, weaken the heart muscle, and disrupt normal blood flow.

This concept is supported by research from the American Heart Association showing a link between prolactin fragmentation and the development of PPCM.

Risk Factors to Watch For

Not every mother develops PPCM, but the risk is higher in mothers with the following conditions:

Risk factor	Brief explanation
Age > 30 years	The risk increases with the mother’s age
Multiple pregnancy	The heart works extra hard to support two or more fetuses
Hypertension / preeclampsia	High blood pressure disrupts blood flow and puts pressure on the heart
Diabetes	Affects the blood vessels and heart metabolism
Obesity	Increases the heart’s overall workload
History of heart disease	Includes a family history or previous heart disease

Personal or Family History of Heart Disease

If the mother:

• has had a heart problem before, or
• has a family member with a history of heart failure or cardiomyopathy,

then the risk of PPCM is higher. In this situation, heart checkups before and after delivery are strongly recommended.

03 / Heart Disease

Signs and Symptoms of PPCM to Watch For

In many mothers, peripartum cardiomyopathy (PPCM) can look like ordinary late-pregnancy complaints. However, PPCM disrupts heart function, so its symptoms tend to be more severe, persistent, and disruptive to daily activities. That is why it is important to recognize the difference early on.

1. Worsening Shortness of Breath

Mild shortness of breath is common as delivery approaches. But with PPCM:

• Breathlessness feels more severe, even during light activity.
• Breathing feels short when lying down or sleeping.
• The mother may need to prop herself up on several pillows to breathe more easily.

2. Extreme Swelling in the Legs or Hands

Mild edema can occur during pregnancy, but with PPCM:

• The swelling looks larger and does not go down after rest.
• The legs feel heavy and tight.
• Sudden weight gain may occur because of fluid buildup.

3. A Fast or Irregular Heartbeat (Palpitations)

When the heart works harder:

• The heartbeat feels fast or irregular.
• Palpitations can appear at rest, not only when tired.

This shows that the heart is trying to make up for its reduced ability to pump blood.

4. Severe Fatigue

With PPCM, even after resting:

• The body still feels very tired.
• Light activities such as walking, breastfeeding, or carrying the baby can feel exhausting.
• The tiredness seems out of proportion to the activity done.

5. A Persistent Dry Cough

A dry cough can appear because of fluid building up in the lungs. It is usually accompanied by:

• Shortness of breath,
• Breathlessness at night,
• Or rapid breathing sounds.

6. Chest Pain or Pressure

The mother may feel:

• Heaviness or pressure in the chest,
• Pain that comes on during activity or when breathing in,
• A sensation of being unable to take a deep breath.

Chest pain is always a sign that must be evaluated immediately.

Telling PPCM Symptoms Apart From Normal Pregnancy Complaints

Complaint	Normal pregnancy	PPCM (needs attention)
Shortness of breath	Mild, goes away with rest	Gets worse, appears even when lying down
Swelling	Mild, goes down during sleep	Gets worse and does not subside
Fatigue	Worse during activity	Remains severe even after rest
Palpitations	Occasional	Fast, pounding, irregular
Cough	Usually due to irritation	Dry, long-lasting, accompanied by breathlessness

When Should You See a Doctor Right Away?

Get checked promptly if:

• Symptoms appear suddenly or get worse quickly,
• The complaints disrupt sleep, breastfeeding, or basic activities,
• Or the mother feels that something is not right with her heart.

Recognizing PPCM symptoms early can help prevent the condition from progressing to more severe heart failure.

04 / Heart Disease

How Is PPCM Diagnosed?

To determine whether the shortness of breath, swelling, or fatigue a mother is experiencing is related to peripartum cardiomyopathy (PPCM) or just normal pregnancy changes, the doctor needs to carry out a structured series of examinations. Early diagnosis is very important because prompt treatment may help restore heart function and prevent serious complications.

1. Physical Examination and Medical History

A cardiologist usually starts by:

• Asking when the symptoms appeared and how their intensity has changed.
• Assessing any history of high blood pressure, preeclampsia, gestational diabetes, or previous heart problems.
• Listening to the heart and lungs for signs of fluid buildup.
• Measuring blood pressure, pulse, and oxygen saturation.

This approach helps determine whether the symptoms point to heart failure due to PPCM.

2. Supporting Tests: Looking at the Structure and Function of the Heart

To confirm the condition of the heart, several imaging tests may be done:

Test	Purpose
Echocardiography (echo)	The main test for assessing the heart’s pumping strength, the size of the heart chambers, and blood flow.
Electrocardiogram (ECG)	Identifies a fast, irregular, or weakened heart rhythm.
Chest X-ray	Assesses heart enlargement or fluid in the lungs.
Cardiac CT scan / MRI	Used when more thorough structural detail of the heart is needed.

Echocardiography (echo) is the key test for assessing heart function in PPCM.

3. Left Ventricular Ejection Fraction (LVEF): A Key Measure for PPCM

The echo results provide the LVEF (left ventricular ejection fraction) value, which is the percentage of blood the heart pumps out with each beat.

• Normal: > 50%
• Suspected PPCM: < 45%

A decrease in LVEF shows a weakened heart muscle, which is the main feature of PPCM according to the American Heart Association (AHA) and the European Society of Cardiology (ESC).

4. Supporting Laboratory Tests

Blood tests help assess the severity of heart failure and the risk of complications:

• BNP or NT-proBNP: rises when the heart is working harder.
• D-dimer: assesses the possibility of blood clots.
• Kidney function and electrolyte tests: make sure other organs stay safe during treatment.

5. Why Is Early Detection of PPCM So Important?

Without early treatment, PPCM can lead to:

• Severe heart failure,
• Arrhythmia (irregular heart rhythm),
• Blood clots,
• Complications that endanger both mother and baby.

That is why you should not ignore symptoms that get worse or feel unusual, especially after giving birth.

Once the diagnosis is confirmed, the doctor will put together a treatment plan that is safe, gradual, and tailored to the mother’s condition and breastfeeding needs.

05 / Heart Disease

Treatment Options for Mothers With PPCM

The treatment of peripartum cardiomyopathy (PPCM) aims to help the heart recover its pumping strength and reduce symptoms such as breathlessness, swelling, and tiring easily. Treatment is given carefully and is personalized to the mother’s condition, especially if she is still breastfeeding or has coexisting conditions such as hypertension or diabetes.

1. Medication: Helping the Heart Work More Efficiently

The doctor may prescribe a combination of medications that may help patients with PPCM, including:

• Diuretics: Reduce fluid buildup in the lungs and legs so breathing is easier and swelling goes down.
• Beta-blockers: Stabilize the heart rate and reduce the heart’s workload.
• Anticoagulants (blood thinners): Given when the heart’s pumping function is very low, to prevent blood clots from forming.
• ACE inhibitors or ARBs: Only given to mothers who are not breastfeeding, because some of these medications can pass into breast milk. These medications help improve and maintain heart function.

2. Oxygen Support and Fluid Management

If breathlessness is severe or oxygen saturation is low, the doctor may give supplemental oxygen to help with breathing.

In addition, intravenous (IV) fluid intake will be strictly regulated so the body does not retain excess fluid that would worsen heart failure.

3. Intensive Care for Severe PPCM

In severe PPCM, the mother may need:

• Hospitalization in an intensive care unit (ICU) or a specialized cardiac unit
• 24-hour heart rhythm monitoring
• Close monitoring of blood pressure and the function of other organs

This approach helps keep the mother safe and allows the medical team to respond quickly if heart rhythm problems or worsening breathing occur.

4. Postpartum Monitoring and Regular Follow-Up

Recovery from PPCM does not happen instantly. Many mothers see improvement within 3 to 6 months, but in some cases recovery can take longer.

Monitoring includes:

• Periodic echocardiography (echo) to check for improvement in the heart’s ejection fraction
• Regular medication reviews to adjust doses and ensure safety
• Ongoing consultations with a cardiologist

Support from family and the people around the mother plays a big role in a successful recovery.

5. A Healthy Lifestyle to Support Heart Recovery

Managing your lifestyle is an important part of treatment:

• Reduce salt in your food
• Get enough rest and manage stress
• Do not smoke and avoid cigarette smoke
• Do light exercise as directed by your doctor (for example, relaxed walking or breathing exercises)

Being disciplined about your lifestyle helps the heart recover more optimally.

06 / Heart Disease

Complications and Long-Term Effects

Although many mothers with PPCM (peripartum cardiomyopathy) may see their heart function improve after treatment, this condition still carries a risk of long-term complications. It is important to understand the possible effects so the mother and family can carry out appropriate and continuous follow-up monitoring.

1. Chronic Heart Failure

In some people with PPCM, heart function does not return to an optimal state even after treatment. This can lead to chronic heart failure, with symptoms such as:

• Shortness of breath during light activity
• Tiring easily
• Swelling in the legs or ankles

Long-term care usually includes medications to support heart function, lifestyle adjustments, and regular evaluations by a cardiologist.

2. Arrhythmia (Heart Rhythm Disorders)

PPCM can increase the risk of arrhythmias, such as atrial fibrillation, which make the heartbeat irregular or too fast. This condition can trigger:

• Palpitations or a pounding heart
• A floating sensation or dizziness
• A risk of fainting or loss of consciousness

Heart rhythm monitoring and medication management are important parts of treatment.

3. Thrombosis and Embolism

Reduced pumping strength can slow blood flow and trigger the formation of blood clots (thrombosis). If a clot travels to the lungs or brain, the mother is at risk of:

• Pulmonary embolism, which causes sudden shortness of breath
• Stroke, caused by a blocked blood vessel in the brain

To prevent this, the doctor may prescribe anticoagulants (blood thinners) as needed.

4. Risk of Serious or Fatal Complications

If it is not diagnosed and treated early, PPCM can develop into a life-threatening condition. That is why timely treatment, especially in the first 6 months after delivery, plays an important role in the long-term prognosis.

5. Chances of Recovery and Considerations for a Future Pregnancy

The good news is that many mothers recover fully within a few months to a year after giving birth with appropriate treatment. However, an evaluation of heart function is strongly recommended before planning another pregnancy, because:

• A subsequent pregnancy can increase the risk of PPCM recurring
• The lower the remaining ejection fraction, the higher the risk of complications

An in-depth discussion with a cardiologist will help determine safe and appropriate options.

07 / Heart Disease

How Can PPCM Be Prevented?

Although PPCM (peripartum cardiomyopathy) cannot yet be fully prevented because its exact cause is still unknown, there are important steps that may help lower the risk. Prevention focuses mainly on monitoring heart health during pregnancy and managing risk factors that can burden the heart.

1. Regular Prenatal and Cardiology Checkups

Regular pregnancy monitoring is very important for detecting changes in heart condition early.

For mothers with risk factors, the doctor may recommend additional tests, such as:

• Echocardiography (echo) to evaluate how well the heart pumps blood
• Electrocardiogram (ECG) to check the heart rhythm

The reason: early detection of impaired heart function can help prevent symptoms from getting worse and make treatment easier.

2. Control Risky Medical Conditions

Several conditions can increase the risk of peripartum cardiomyopathy, especially if they are not well managed during pregnancy:

• Hypertension and preeclampsia
• Gestational diabetes
• Severe anemia

Preventive measures include:

• Checking blood pressure regularly
• Regular consultations with an obstetrician and a cardiologist
• Adjusting medications according to medical advice

Good management helps protect the heart from an excessive workload.

3. Adopt a Healthy Lifestyle

Lifestyle plays an important role in supporting the mother’s health during pregnancy.

Recommendations from doctors:

• Eat nutritious food rich in vegetables and fruit
• Limit salt to reduce fluid buildup
• Keep your weight gain steady and appropriate for your stage of pregnancy
• Do light physical activity such as walking or prenatal yoga (with your doctor’s approval)

These simple steps help keep your heart rate stable and your blood pressure under control.

4. Avoid Risk Factors That Burden the Heart

To protect your heart health during pregnancy, it is advisable to avoid:

• Smoking
• Alcohol
• Illegal drugs
• Prolonged stress that is not managed

Emotional support from a partner and family plays a big role in maintaining the mother’s mental balance.

5. Recognize and Watch for Early Symptoms

Self-awareness is an important part of prevention. If you experience:

• Excessive shortness of breath
• An abnormal heartbeat
• Swelling in the legs or ankles
• Extreme fatigue

Consult a doctor promptly.

The sooner PPCM is recognized, the greater the chance of optimal recovery.

Preventing PPCM involves not only medical care, but also strong support from family and the people around the mother. A sense of calm, understanding, and companionship can help the mother go through pregnancy and the period after delivery more safely and confidently.

08 / Heart Disease

Support for Mothers and Families

Recovering from PPCM (peripartum cardiomyopathy) is not only about medical treatment. This condition also requires strong emotional and social support from the people closest to the mother. The presence of family, a partner, and an empathetic environment can help the mother feel calmer and not alone in the recovery process.

1. Emotional Support From Close Family

Mothers with PPCM may experience anxiety, fear, or emotional exhaustion. That is why family support is an important foundation.

Simple things such as:

• Keeping the mother company and talking with her,
• Listening to her concerns without judging,
• Offering words of encouragement and appreciation,

can provide a sense of security and improve the mother’s mental well-being.

2. Psychological Support and Professional Counseling

Besides family support, some mothers may need professional help to manage stress or emotional burdens.

According to PDSKJI (the Indonesian Psychiatric Association), counseling helps:

• Reduce anxiety,
• Increase a sense of self-control,
• Lower the risk of postpartum depression.

Support groups with other mothers who have experienced PPCM can also be a space to share and encourage one another.

3. The Partner’s Active Role

The partner plays an important role in the recovery process. Real, everyday help can greatly lighten the mother’s load.

For example:

• Helping with housework and caring for the baby,
• Reminding her of medication times and doctor’s appointments,
• Giving the mother the chance to rest more.

A partner’s active involvement helps speed up recovery and keeps the mother’s emotional state more stable.

4. The Importance of Empathy and Understanding

It is important to remember that PPCM is not the mother’s fault and is not the result of failing to take care of herself.

That is why the family should:

• Avoid criticism or blaming comments,
• Use gentle and supportive language,
• Appreciate every step of progress in recovery, no matter how small.

An empathetic environment strengthens the mother’s confidence in her healing process.

5. Family Education for Optimal Support

The better the family understands what PPCM is and how to monitor its symptoms, the more effective the support they can provide.

Families can:

• Ask the doctor directly about the condition and the care plan,
• Read credible medical guides,
• Write down the symptoms to watch for and when to seek help immediately.

With the right support, mothers with PPCM can go through the recovery period more easily and confidently. However, it is still important to know when the condition needs immediate medical attention so the risk of complications can be reduced as early as possible.

09 / Heart Disease

When Should You See a Doctor Right Away?

With PPCM (peripartum cardiomyopathy), recognizing warning signs early is very important to prevent more serious complications. If symptoms appear suddenly or get worse, see a doctor promptly, especially a cardiologist. Do not wait until the complaints get worse.

Here are some conditions that require immediate medical attention:

1. Symptoms That Suddenly Get Worse

Shortness of breath or fatigue that was previously mild but suddenly becomes severe may indicate that the heart is under high strain. This condition needs to be evaluated quickly to prevent heart function from getting worse.

2. Difficulty Breathing When Lying Down or Waking Up Breathless

Difficulty breathing when lying down (orthopnea) or suddenly waking up at night because of breathlessness (paroxysmal nocturnal dyspnea) may be a sign of fluid buildup in the lungs due to heart failure. These are symptoms that should not be ignored and need to be confirmed through a doctor’s examination.

3. Rapid Swelling With Sudden Weight Gain

Watch out if:

• Swelling in the feet, ankles, or legs keeps getting bigger, and
• Your weight goes up by more than 2 kg in 1 to 2 days.

This can happen because of increased fluid retention, which may indicate that the heart cannot pump blood optimally.

4. A Strong, Irregular, or Very Fast Heartbeat

A feeling of a strongly pounding heart (palpitations) or an irregular heart rhythm (arrhythmia) can be a sign of an imbalance in the heart’s electrical activity. If left untreated, this condition can cause dizziness, severe breathlessness, and even fainting.

5. Chest Pain, Severe Dizziness, or Fainting

Go to the emergency department (ER) immediately if you experience:

• Severe chest pain that feels like pressure,
• Severe dizziness to the point of losing your balance,
• Fainting or nearly fainting.

These symptoms may point to an emergency such as a heart attack or pulmonary embolism that requires immediate treatment.

Important to remember!

• It is better to act quickly than too late.
• The family plays an important role in recognizing symptoms and bringing the mother to a medical facility.
• Write down changes in symptoms, including when they started and how they developed, to help the doctor assess the condition more accurately.

Not every mother with PPCM goes through the same recovery journey. However, with good monitoring, appropriate treatment, and consistent emotional and physical support, many mothers can return to a good quality of life.

10 / Heart Disease

Hope and Recovery: What You Need to Know

Facing PPCM (peripartum cardiomyopathy) can be a challenging journey for mothers and their families. However, it is important to know that with the right diagnosis, emotional support, and regular care, many mothers can recover and go on to live an active and healthy life.

1. Heart recovery can go well

In many cases, heart function can return to near normal within 6 to 12 months after treatment begins. This outcome is more likely if PPCM is detected early and the mother follows her treatment consistently.

Regular monitoring and adherence to treatment play a big role in successful long-term recovery.

2. Long-term follow-up is still needed

Even when symptoms have improved, regular heart checkups are still needed to make sure no problems remain. These checkups may include:

• Echocardiography to assess the heart’s pumping function
• Blood pressure and pulse checks
• Evaluation of daily symptoms such as breathlessness or tiring easily

The doctor may adjust doses or gradually stop medications depending on how the heart is recovering.

3. Considerations for a future pregnancy

If the mother plans to become pregnant again, a consultation with a cardiologist and an obstetrician is strongly recommended.

This is important because a subsequent pregnancy can increase the risk of PPCM recurring, especially if heart function has not fully recovered. Evaluating the heart before pregnancy can help the mother and doctor make a safe and informed decision.

4. A healthy lifestyle supports recovery

Lifestyle changes can greatly help the healing process. Mothers can start with simple steps:

• Eating balanced meals that are low in salt and rich in vegetables and fruit
• Exercising lightly and regularly under a doctor’s supervision
• Planning rest periods and avoiding excessive fatigue
• Managing stress through relaxing activities you enjoy

This approach helps strengthen heart function and increase the mother’s daily energy.

5. An optimistic attitude plays an important role

Recovering from PPCM requires not only medical care, but also emotional support and a calming atmosphere.

With family support, an understanding of the condition, and open communication with health workers, mothers can go through this process with more confidence and hope. Many mothers with PPCM are eventually able to return to their daily activities with a stable condition and a good quality of life.

11 / Heart Disease

Conclusion

PPCM (peripartum cardiomyopathy) is a serious condition that can affect a mother’s heart health after pregnancy. However, by recognizing symptoms early, getting appropriate medical treatment, and receiving strong emotional support from family, many mothers can get through this period safely and recover well.

One of the most important things is building an empathetic environment. Mothers with PPCM did not choose to be ill, and this condition is no one’s fault. That is why support from partners, parents, and the people closest to them means a great deal in helping mothers feel safe, valued, and not alone in the recovery process.

In addition, educating the family together is also important. Understanding what PPCM is, the symptoms to watch for, and the appropriate treatment steps can help prevent delays in care and reduce the risk of complications. Additional information about this condition can be found through international heart organizations such as the American Heart Association (AHA): https://www.heart.org.

In the end, there is always hope. Many mothers successfully return to a healthy life after PPCM. With appropriate treatment, a lifestyle that supports heart health, and mutual support, the recovery process can feel lighter and more hopeful.

If you or someone close to you has symptoms related to PPCM (peripartum cardiomyopathy), consult the nearest health facility promptly.

Quick and appropriate action can save lives and make room for a better recovery.